Patient-Centered Approach to Surgical Prevention of Ovarian Cancer

Importance: Risk-reducing salpingo-oophorectomy (RRSO) is an effective option to prevent ovarian cancer in high-risk individuals, but adverse effects from premature menopause are a barrier to uptake. Interval salpingectomy with delayed oophorectomy (ISDO) may be an effective alternative. Objective: To evaluate the association of ISDO vs RRSO and sexual function and menopausal symptoms. Design, Setting, and Participants: This prospective, multicenter, nonrandomized (patient preference) clinical trial was performed among Women Choosing Surgical Prevention participants with a pathogenic or likely pathogenic germline variant conferring an increased risk for ovarian cancer. Patients from 9 US centers were enrolled from June 2, 2016, to October 28, 2020; chose ISDO or RRSO; and were followed up for 24 months. The analysis was performed on November 13, 2024. Interventions: Participant-selected RRSO or ISDO. Main Outcomes and Measures: Changes in sexual function and menopausal symptoms from baseline to 6, 12, and 24 months. Inverse probability weighting was applied to achieve covariate balance across groups. Results: The analytic sample included 334 female participants (mean 95% CI age at consent, 39.2 38.7-.9.7 years) who underwent RRSO (n = 165) or ISDO (n = 169) and completed 6-month questionnaires. Significantly more participants experienced clinically meaningful worsening of sexual function at 6 months compared with baseline after RRSO vs ISDO (33.1% 39 of 118 vs 16.8% 17 of 101, respectively; odds ratio, 2.00 95% CI, 1.20-3.35) and at 12 months (39.2% 38 of 97 vs 18.3% 17 of 93, respectively; odds ratio, 1.69 95% CI, 1.09-2.63). This finding was no longer significant at 24 months. When restricted to the RRSO group who took hormone replacement therapy, there was no significant worsening of total sexual function scores or menopausal symptoms compared with baseline. No interval ovarian cancers were reported. Conclusions and Relevance: This nonrandomized clinical trial comparing RRSO with ISDO found that ISDO was less likely to impair sexual function, which addresses an important barrier to surgical prevention in high-risk patients in premenopause. After RRSO, use of hormone replacement therapy mitigated menopausal symptoms and prevented decline in sexual function. More information is needed about the safety of ISDO. Trial Registration: ClinicalTrials.gov Identifier: NCT02760849.